Not every person that comes through your door is going to be an elite athlete or in perfect health. Some individuals will come in with various injuries or conditions that may not seem commonplace. That doesn't mean you have to turn them away. Instead you need to be equipped and prepared to work with all types of populations*. If you want to be a decent coach you need to know how to work with and successfully program for individuals with physical, cognitive, or behavioral conditions.

What Is A Special Population

Most people think of serious and visible injuries as constituting a special population. Special populations are actually much broader. Special populations are defined as "individuals suffering from chronic or temporary health conditions." Theoretically almost any injury, long term or short term, will categorize someone into a special population.

For the purposes of this article we are going to discuss special populations in three different categories or domains: physical, cognitive, and behavioral conditions. We will examine subsets of each category below, but be aware there are some overlaps among the domains and every person has his or her own set of individualized conditions.

• Physical Conditions: These conditions center around structural imbalances and joint misalignments. (1) Metabolic Conditions: diabetes, obesity; (2) Neuromuscular Conditions: Down's syndrome, cerebral palsy; and (3) Musculoskeletal Conditions: cystic fibrosis, scoliosis, osteoporosis, amputations.
• Cognitive Conditions: These conditions concern the learning speed of the athletes and how they process information. Examples of these conditions include ADHD, dementia, Asperger's syndrome and brain injuries.
• Behavioral/Social/Emotional Conditions: These conditions tend to overlap with those in the cognitive domain. Examples include those athletes from an abusive background, sheltered environments (group homes), autism, anxiety, depression, and disordered eating.  
• Other Conditions: deafness, blindness, pregnancy (and post pregnancy), as well as age (e.g. youth, seniors/masters).

Precursors To Training Special Populations

Setting up a Standardized Operating Procedure for new clients, regardless of their condition, should be a priority if you are going to coach anyone. How are you going to maintain (and protect) client files, what is your intake form going to ask, what assessments are you performing at the outset, will you be requiring a HIPPA form, how are you going to take notes during each session?

As a coach you should always be doing consults and screenings with new or potential clients. During these consults, you should be doing assessments to see what movements the client is able to do, what cues work best for), and have them sign a release waiver. If the individual has a cognitive impairment or is a minor then make sure you get a parent, guardian, or caretaker to sign the release waiver as well. If you aren't sure if the caretaker should sign, make sure to have them sign it in addition to the client.
If applicable, and the client accepts and signs a HIPPA form, you should also be in touch with the client's healthcare provider. This could be a doctor, a physical or occupational therapist, a psychologist, or a chiropractor. The more you know about the individual's condition and/or what medications they are on, the better able you are to work in conjunction with their provider to improve their quality of life to the best of your abilities.

Training Special Populations

Special populations do not require you to wear kid gloves when coaching. These individuals are still human beings and should be treated with the same respect and dignity you give anyone else. The only difference is how you approach coaching the lifts with them based on what their condition is.
Regardless of their condition, all populations should have a sufficient warm-up and cool down before jumping into their training. (That shouldn't be news to you, but you'd be surprised how often I see these steps overlooked.)

• Physical Conditions: These conditions are based around muscular tonal changes. It may require a more trained coach to spot and rectify, but that does not mean you need to be an occupational therapist or physical therapist to do so. So long as you have experience working with these athletes, you can easily spot some of their conditions. Even if you do not have experience, a careful eye will still benefit you and your client. 

Metabolic conditions, like diabetes and obesity, require special attention to the intensity and duration of training. Overweight athletes will be putting a lot more stress on their joints than some other athletes. Start them off with low impact cardiovascular exercises and strength movements. You wouldn't start them with box jumps on their first day. Instead begin with step-ups and progress to higher impact exercises as able.
 
Neuromuscular conditions, like Down's syndrome and cerebral palsy, concern tonal changes. Down's syndrome athletes will have low muscle tone and lax joints; they will be hyperflexible. While being flexible is important in weightlifting this will cause a decrease in stability. Ensure you are providing strengthening exercises and core work to help balance the athlete. Cerebral palsy is the opposite of Down's syndrome; these athletes have high muscle tone to the point their muscles are extremely tight. You may note bent elbows, hips, and knees. Work on appropriate stretches for those areas and dumbbell exercises to help balance their structural stability. Strength training has been shown to improve walking speed or cognitive functions in these athletes. Short intervals, through rowing or leg cycling, with a focus on the athlete's head, shoulder, and hip alignment are crucial. Overuse injuries are common so be sure to vary your durations and exercises for these athletes.
 
Musculoskeletal Conditions: These conditions concern "injuries or pain in the body's joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back." Examples include scoliosis, osteoporosis, and amputations. The most common condition you will encounter will be scoliosis, which affects the spinal alignment of the athletes. The easiest way to assess if your athlete is afflicted with this condition is to stand behind them while they bend over to touch their toes to see if there is a twist of the spine. Squats, pulls, and deadlifts are good for these athletes, under supervision, as they will strengthen the muscles around the spine and help with pain and posture.

• Cognitive Conditions: Since these conditions concern the concentration and processing ability of the athlete, they can be the most difficult to work around. However, that does not mean the athlete cannot or will not benefit from strength training. Studies have shown the increase of activity for ADHD individuals increases dopamine levels, which helps them, focus at home or school. (Strength training has also been proven to help dementia and Alzheimer's patients as well.) Athletes with brain injuries who exercise improve their depression, fatigue, and cognitive impairments (to an extent). These athletes may have a hard time focusing or balancing for long periods of time, so you may need to work with them in 2-3 minute intervals before giving them a break or letting them move on to another task. When starting out with these individuals, begin with dumbbells or kettlebells. This will help train balance at the same time which is something brain injured individuals can have a hard time handling.

You may have to use different cues than what you are used to for these athletes to properly process what you are telling them; one cue at a time works best because some conditions will hyper focus on one thing. It is important to note you should not get visibly frustrated or angry if the athlete is taking more time to understand what you are telling them.
 

• Behavioral Conditions: The most important thing to remember when coaching athletes with behavioral or societal conditions is to be cognizant of what feedback you give them. These individuals come from a variety of backgrounds (abusive homes, sheltered environments like group homes) and should be approached dependent on their individual circumstances.

Group environments may not be the best training environment when these individuals are   starting out. For example, autistic individuals can be triggered by loud noises, so having them train separately may benefit them while they get used to their new routine. The feel of the barbell may trigger them, so see how they react to it before you put them through intense movements; gloves could be an option. Emphasis on strengthening their core and developing a structured routine to learn the lifts is important. Other individuals with behavioral conditions could lash out (via anger or sadness) if they perceive you are making fun of them, their lifting, or their ability to process what you are telling them. Individuals with Asperger's may be unable to tell you how a movement "feels," understand a particular cue, or comprehend a metaphor you have given them. This could be frustrating as a trainer but continue to try and find a cue that works for them.  
 
Disordered eating athletes should be praised for their performance and comments about their physical appearance should be avoided. "Aerobic and anaerobic exercise" for mild to moderate depression is beneficial; weightlifting, an anaerobic exercise, gives depressed athletes accountability and routine. Be aware that depressed individuals have a difficult time functioning some days and may not be as consistent as some other athletes. Make sure to shoot them an encouraging message when you notice their absence but do not berate them for failing to attend practice.
 

• Other Conditions: Deaf athletes will respond best to visual cues whereas blind athletes will need more auditory or tactile (hands on) cueing. If you plan on touching an athlete, please always let them know when you are about to do so. Pregnant athletes require special considerations dependent on their trimester and personal health conditions during their pregnancy. Youth athletes require gradual progressions in technique and strength. Masters athletes require less volume and more recovery. 

Conclusion
Regardless of an athlete's condition when they seek your help, you should be able to help them. After your first assessment of them, make sure to stay in contact with their healthcare provider if they are a member of a special population to ensure their program is efficient and safe. Don't be afraid to ask them what modifications they may require during their consult and always leave the door open for future discussions or modifications. Whether they have physical, cognitive, behavioral, or temporary conditions, you are now equipped to train them effectively and without causing injury.
 
* I’d like thank Tyler Smith for his help during the research of this article. Tyler is Licensed Occupational Therapist who received his Master's of Occupational Therapy from the University of Mississippi Medical Center and B.S. Exercise Physiology and Kinesiology from Mississippi State University. He currently serves as the President of Mississippi Barbell.